We conducted an inspection of Eleanor Nursing and Social Care Ltd - Leegate Office on 5, 6, 7 and 9 November 2018. At our previous inspection on 30, 31 August and 4 September 2017 we found a breach of regulations relating to the safe care and treatment of people.

This service is a domiciliary care agency. It provides personal care for people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults. At the time of the inspection they were supporting approximately 520 people. Not everyone using Eleanor Nursing and Social Care receives a regulated activity. The Care Quality Commission only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There had been concerns about the high number of safeguarding and quality alerts received since the provider’s commencement of a large contract for one local authority. At the time of the inspection one local authority that commissioned the provider’s services were working with them to support them to make improvements.

Risk assessments and care plans contained some information for staff, but we saw many examples of incomplete record keeping, including a lack of written risk management guidelines. Therefore, we could not be assured that people were protected from avoidable harm.

Medicines were not always accurately recorded when care workers administered them, so it was not always possible to determine what medicines people had taken and when.

The provider had appropriate safeguarding procedures in place and care staff were aware of these. Care staff had received training in safeguarding procedures and demonstrated an understanding of the signs of abuse and how they were expected to respond to this.

Care staff had a good understanding of their responsibilities under the Mental Capacity Act 2005. However, records did not always contain details of people’s capacity and records were often not signed by the person using the service or their legally authorised representative. Therefore, we could not be assured that people’s rights were being protected.

Staff had a good level of knowledge about people’s current circumstances and supported people to meet their needs in a caring way. However, care records contained very limited details about people’s individual needs or preferences.

People we spoke with and their relatives told us they were involved in decisions about their care and how their needs were met.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which helped prepare them for their role. However, care staff did not receive regular supervisions, spot checks or appraisals of their performance. Care workers received appropriate training to help them carry out their duties.

People told us they were supported with their nutritional needs where this formed part of their package of care. However, care records contained very limited information about people’s dietary needs and care workers responsibilities in relation to this.

Appropriate and thorough investigations were not always conducted into complaints and incidents that occurred during the delivery of care.

Information was not reported to the CQC as required. We found evidence of safeguarding incidents that were not reported in line with requirements. An action plan was in place which mirrored the findings in our inspection, but the service ne

We conducted an inspection of Eleanor Nursing and Social Care Ltd - Leegate Office on 30, 31 August and 4 September 2017. This was our first inspection of the service since it was registered in July 2017. The service provides care and support to people living in their own homes. There were 300 people using the service when we visited.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risk assessments and support plans contained some information for staff, but we saw many examples of incomplete record keeping that meant staff may not have always the information they required to support people safely and effectively.

People received their medicines safely. Care workers appropriately recorded which medicines they were prompting people to take within their daily records and were filling in medicines administration records (MARs) when they administered medicines to people.

Safeguarding adults from abuse procedures were robust and staff understood how to safeguard people they supported. Staff had received safeguarding adults training and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005. However, records did not always contain accurate details of people’s capacity to make decisions about their care. People using the service and their relatives were involved in decisions about their care and how their needs were met.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way. However, care records contained limited details about people’s individual needs or preferences.

Recruitment procedures helped ensure that suitable staff worked within the service. There was an induction programme for new staff, which prepared them for their role.

Care workers were provided with appropriate training to help them carry out their duties. Care workers received regular supervision and appraisals of their performance. There were enough staff employed to meet people’s needs.

People were supported to maintain a balanced, nutritious diet where this formed part of their package of care. However, care records did not always contain enough information about the support people with diabetes required in relation to their diet.

People using the service and staff felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place.

The organisation had systems in place to monitor the quality of the service, but these were not always effective. Various audits were conducted by an internal quality assurance officer, but these did not identify the issues found. Information on significant events was reported to the Care Quality Commission as required.

During this inspection we found a breach of regulations in relation to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.